VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1779621
Sex: F
Age: 50
State: CA

Vax Date: 04/08/2021
Onset Date: 04/10/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None 07/03/2021 hospitalized for 5 hours

Allergies: Allergy relief--Zyrtec Allergy

Symptom List: Dysphagia, Epiglottitis

Symptoms: I am pre-menopausal but began getting my period again-period continued every month for 4months muscle aches, joint pain, insomnia and vision issues- tired and blurry

Other Meds: Multivitamin Allergy Pill CoQ10 Magnesium Iron Cingulin Tylenol Ibuprophen

Current Illness: none

ID: 1779622
Sex: F
Age: 46
State: TX

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: EMS reported BG = 78; BP = 140/90; P = 71; and O2 sats = 99%. EMT also reported normal EKG results.

Allergies: Flagyl, Codeine, NSAID's

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccination administered to L deltoid at 1250pm with no issues or complaints until 10 minutes later. Patient reported numbness and tingling to L arm, where injection was given, at 1255pm and then reported feeling slight SOB and mild chest tightness around 1305 pm. Requested assistance by LVN,, to monitor patient while NP was being retrieved for medical evaluation. NP presented where a presyncopal episode occurred with patient already reclined in chair; vitals were taken with O2 Sats ranging from 97% to 100% with pulse rate ranging between 67 to 71, RR at 14 - 18 breaths per minute. Breathing was noted to be non-labored. BP was attempted multiple times on LA by RN and LVN before obtaining 139/88 with larger cuff. NP offered to give patient epinephrine, but patient declined as she did not want to go to the hospital. Patient then ? lightheadedness, nausea and scratchy throat as well as facial flushing and feeling hot. Noted productive cough with clear and foamy sputum. Provided water; tolerated well with no emesis. OHN recommended that she contact her closest relative for pick up from TAO to rest. LVN remained with patient for direct observation while patient was allowed time to recover from her reported symptoms. LVN reported to OHN patient ? numbness and tingling around her lips and cheeks as well as weakness in her arms and legs when NP and OHN returned to check in on patient. Noted that patient was on phone with relative discussing pick up from work. Patient was offered epinephrine again by NP, but again declined. Provided stand-by assistance while patient stood up and ambulated slowly to the restroom and was allowed to proceed without direct observation. Patient was noted to be already standing upright when restroom door was opened for escort to sink. Patient reported feeling faint again and was then placed into a chair while EMS was contacted. Patient remained awake and responsive following commands appropriately during entire monitoring period.

Other Meds: Patient did not disclose

Current Illness: Patient did not disclose, but reports history of COVID-19 Illness x 2, pleurisy, gastroparesis, anxiety, syncopal episodes, and hypoglycemia

ID: 1779623
Sex: M
Age: 65
State: GA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: Vaccine was administered after manufacturer expiration date. Patient notified. Manufacturer notified. Manufacturer classified the dose as a valid dose for protection against COVID-19. Manufacturer report attached.

Other Meds:

Current Illness:

ID: 1779624
Sex: M
Age: 47
State: CA

Vax Date: 06/25/2021
Onset Date: 07/16/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Before I begin let me frame things. I am listing my receiving of the Pfizer shot, but on April 8, 2021 I received the one shot Johnson & Johnson vaccine. In July as the delta variant was becoming more prominent I was strongly encouraged by my girlfriend and my mother to get a mRNA vaccine as well. I got the Pfizer shots at the walk up clinics, where they did not ask if I had had any other vaccines. Two days after the final vaccination shot (7/16) I remember feeling very fatigued. So much so that I had to leave lunch and lie down. I continued to feel run down and a lack of energy for the week, but nothing to make me concerned. That Friday night (7/23) I started feeling feverish to the point where it was disturbing my sleep. Sunday night (7/25) I awoke with a 102? fever and become worried that I was infected with COVID. The next day (7/26) I took a COVID test, but it came back negative two days later. I continued to have fevers that lasted 10-12 hours around 101-102? every day. On Thursday (7/29) I asked for help from my doctor to relieve these symptoms. They ordered a blood test and chest x-ray. On Sunday (8/1) I had a doctors appt and she recommended I by admitted to the emergency room where I got fluids. I was released later that day with still no diagnosis. On 8/2 I finally got a call informing me that I was infected with mononucleosis.

Other Meds: I take over-the-counter sleep aids regularly.

Current Illness:

ID: 1779625
Sex: F
Age: 77
State: CA

Vax Date: 10/04/2021
Onset Date: 10/06/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: NO

Allergies: no

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: SWELLING AND REDNESS ON INJECTION SITE.

Other Meds: no

Current Illness: no

ID: 1779626
Sex: M
Age: 63
State: MT

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: none

Allergies: Losartan

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: Pt given a Pfizer booster 2 times within 5 days, in error. #3 Pfizer vaccine given 10/7/21, and 4th given 1012/21

Other Meds: Allopurinol

Current Illness: none

ID: 1779627
Sex: F
Age: 77
State: CA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: very sensitive to anesthetics: demerol, propofol, fentanyl -

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Moderate itching of forehead, eyebrows, and scalp. Took a Benadryl before bed and all is well today. I'm just reporting this because it may be an additional side-effect, but it's not serious.

Other Meds: metformin, synthroid, fosinopril, prem-pro, statin (can't remember the name)

Current Illness: none

ID: 1779629
Sex: F
Age: 33
State: CA

Vax Date: 09/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: I received the 1st pfizer vaccine on 9/2/21. A day later I felt tired and weak, nothing too serious. I got the 2nd dose on October 3rd and a day layer I felt like my whole body was in a cast, I could barely move. My left arm was so painful & under my armpit was very swollen. Back pains and body aches all over & feverish with hot & cold sweats on and off for 12 hours. I took 3 tylenol and seemed to feel better afterwards. Major pelvic area pain bad cramping without me even being on my period. Finished my period and huge blood clots came out (that I never experienced before). Mild blurred vision in my eyesight.

Other Meds: none

Current Illness: none

ID: 1779630
Sex: F
Age: 27
State: TX

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: Suprax, sulfa drugs

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sharp chest pain in sternum area accompanied by difficulty breathing. Pain was gone two hours after taking Tylenol.

Other Meds: tylenol, vitamin d, calcium, vitamin c, paragaurd IUD

Current Illness: N/A

ID: 1779631
Sex: F
Age: 57
State:

Vax Date: 08/15/2021
Onset Date: 08/16/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: ( maybe Sulphur.)

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Swollen left side inside of THROAT, like "blocking" the throat and very irritated. Excessive coffing and dryness inside the mouth and throat, specially at night or lying down. Left ear is swollen and very painfull, and all this is giving me a painful headache all the time. My left nose has blood clots when I wwake up in the mprning and bleeds heavelly for some minutes when I wake up.This started when I took the vaccine and is getting worst, some nights it is so painful that I don't sleep.The hospital told me to go see my doctor. I called my doctor and tried to go to walking clinics.Everyone is busy or not seeing patients, just phone call.

Other Meds: No.

Current Illness: No.

ID: 1779632
Sex: F
Age: 38
State: GA

Vax Date: 09/19/2021
Onset Date: 10/07/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Ceftin

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: After my 1st covid vaccine on 9/19/21 I started my menstrual cycle as usual and when I should have started. My cycle was on time but clotting was present. After my 7 day cycle stopped I continued having bad "stomach cramps" that are consistent with a menstrual cycle for a week. No bleeding noted for that week. Then I started bleeding again and clotting is present. I haven't had any issues with my cycle, it has been normal and consistent for many years. A change took place after my first covid vaccine. My cycle is ongoing at the present time.

Other Meds: None

Current Illness: Covid

ID: 1779633
Sex: M
Age: 23
State: WA

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: I was taken to a room with medical equipment (instead of the waiting room) and a nurse checked my blood pressure, heart rate and oxygen. heart rate and oxygen were normal, but my blood pressure was low at about 95/54. I suppose this would qualify as "Doctor or other healthcare profession office/clinic visit" below.

Allergies: Food allergies: Peanuts, tree nuts, eggs, soy protein, soy flour, kiwi, nectarines, tuna fish

Symptom List: Rash, Urticaria

Symptoms: About 5 minutes after injection, I became lightheaded and nearly fainted. The lightheadedness cleared up about 30 minutes after injection.

Other Meds: Levothyroxine 50mcg each morning at 8AM, generic multivitamin, B-Complex, 25 mcg Vitamin D3

Current Illness:

ID: 1779634
Sex: F
Age: 77
State: NC

Vax Date: 04/09/2021
Onset Date: 04/12/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: No

Allergies: No

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Fever, fatigue, headache

Other Meds: Calcium D3 melatonin, turmeric, t3/t4

Current Illness: No

ID: 1779635
Sex: F
Age: 76
State: CA

Vax Date: 10/07/2021
Onset Date: 10/10/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NO

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: PAIN, REDNESS AND SWELLING AT INJECTION SITE

Other Meds: NO

Current Illness: NO

ID: 1779636
Sex: M
Age: 29
State: CO

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Sore arm for 24 hours. No other effect

Other Meds:

Current Illness:

ID: 1779637
Sex: F
Age: 40
State: OR

Vax Date: 09/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Lactose

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Body aches for 2 days following second shot, couldn't get out of bed, headache.

Other Meds:

Current Illness:

ID: 1779638
Sex: F
Age: 51
State: WA

Vax Date: 04/08/2021
Onset Date: 09/26/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: 9/28/2021: PCR Covid test

Allergies: non

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Positive Covid diagnosis

Other Meds: Synthroid (generic)

Current Illness: none

ID: 1779639
Sex: F
Age: 79
State: OH

Vax Date: 06/29/2021
Onset Date: 07/06/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: yes

Allergies: metphorin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Her mother has been having prolonged paralysis. She can't move her body. She stated that her mother has now become like a limp rag. She is not talking and she wasn't like this before she took the vaccine. Her throat closed and started having trouble swallowing and the food kept coming back up. She is now tube fed.

Other Meds: amlodipine, lisinopril, metoprolol, cholesterol blocker, pravastatin, kap spargo sprinkle,

Current Illness:

ID: 1779640
Sex: F
Age: 49
State: CA

Vax Date: 03/10/2021
Onset Date: 03/30/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: gynecological clot removal

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: vaginal thromboses

Other Meds: none

Current Illness: migraines

ID: 1779641
Sex: F
Age: 58
State: CT

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data: None

Allergies: Tdap and ,flu vaccines Crestor

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: Severe left arm pain from fingers to shoulder Fever, chills, nausea, vomiting and rigors Syncope

Other Meds: Lexapro Lipitor Zetia

Current Illness: None

ID: 1779642
Sex: F
Age: 74
State: MA

Vax Date: 10/10/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Labs essentially normal

Allergies: No known drug allergies

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: Fever of 104.7, altered mental status.

Other Meds: Pravastatin 20 mg daily Prednisone total of 20 mg daily Metformin 500 mg daily Lisinopril 20 mg daily Hydroxychloroquine 200 mg twice daily

Current Illness: None

ID: 1779644
Sex: F
Age: 58
State: CA

Vax Date: 10/08/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: covid test 10/12/21 - negative flu test 10/12/21 - negative

Allergies: nka

Symptom List: Unevaluable event

Symptoms: symptoms:body aches;joint pain; headache; fatigue; runny nose; treatment:Teledoc recommended covid test; was tested. outcome: Covid test negative; flu test negative.

Other Meds: buproprion spironolactone abilify losartan furosemide concerta duloxetine lamotrigine jardiance metformin metoprolol tylenol benadryl lactaid B complex omega 3 multi-vitamin

Current Illness: n/a

ID: 1779645
Sex: M
Age: 30
State: UT

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Stress Echocardiogram-5-17-21- No abnormal results. Holter Monitor-5-20-21- No abnormal results Wellness Exam-8-4-21- No abnormal results. Pending Cardiologist Visit due to heart palpitations, shortness of breath, near syncope.

Allergies: n/a

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Heart palpitations, shortness of breath, and near syncope x 8 episodes, Year of 2021. With any physical exertion, I have had above symptoms mentioned. Symptoms will last 5-10 minutes, I have to lay down on my back and raise my legs up in the air to alleviate my symptoms. No previous h/o of heart problems prior to vaccination.

Other Meds: Ibuprofen and Tylenol for chest pain, fever, body aches date after vaccination.

Current Illness: n/a

ID: 1779646
Sex: M
Age: 77
State: CA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Kidney Test - Normal

Allergies: No

Symptom List: Injection site pain, Pain

Symptoms: I experienced extreme diarrhea the next day after receiving the vaccine and was dehydrated and had to go to the ER (prescribed Imodium for the diarrhea and recommended liquids for the dehydration. The doctor also tested my Kidneys to make sure they were functioning properly. I went to see a Urologist and another test was performed. The results came back negative for any issues with my Kidneys and now I am doing fine.

Other Meds: I took the following medications: Metoprolol 50 mg (2x per day), Hydrochlorothiazide 25mg (daily), Atorvastatin 10mg (daily), Warfarin 2.5 mg (2 per day except Monday - 3), Klor-Con 8mg (2x per day), Lisinopril 20mg (daily), AREDS (2 per d

Current Illness: No

ID: 1779647
Sex: F
Age: 72
State: IL

Vax Date: 10/08/2021
Onset Date: 10/11/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: Penicillin, Iodine, green beans, kidney beans,

Symptom List: Injection site pain, Menorrhagia

Symptoms: Sore arm initially, mild headache and slight runny nose. Three days later I still had a dull headache and noticed itching at the injection site. Four days later I noticed a large rash on my arm that was hot and itchy . I contacted my Doctor and was,advised to take an antihistamine like Claritin .

Other Meds: Calcium, multivitamin, Vit D, Omega 3, Curcumin

Current Illness: Osteoporosis, Thyroid nodules, torn rotator cuff

ID: 1779648
Sex: M
Age: 63
State: WA

Vax Date: 05/17/2021
Onset Date: 06/01/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: statins

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: shoulder froze, arm hurting

Other Meds: aspirin, acephex, metoprolol, lavallo, doxycycline

Current Illness:

ID: 1779649
Sex: F
Age: 60
State: NY

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: August 8th - 07:00 PM ER tests - marker showed that I had a possible blood clot. bloodwork and chest x-ray was done. When they did an MRI (at ER) it did not show a blood clot.

Allergies: Augmentin; Bactrim; Zithromax

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After 25 minutes, my lips and nose started to itch. It felt like my lips were swelling. I went to the store and got Benadryl but called my primary care doctor first before taking it. She said to monitor it first. At about 10 pm at night, it began with a headache. I took Advil. I went to bed and woke up with the headache still and had body aches; chills during the night; fatigue; weakness; it was just like a massive flu. I was down and out. To the point where I couldn't go to work for two days. I had the fever - I think it got to 101. I had difficulty when I went back to work and when climbing stairs going from one floor to the next with a mask on. People commented that they could hear I was struggling to breathe. There was not fever that day, though. I couldn't even get dressed on day 2. It took awhile for me to get all the way better with my breathing, etc. It was a struggle - it took at least a week. In August, I was at a wedding, we don't still know but I felt like I was having a heart attack. I had a stabbing back pain and couldn't breathe, nausea, couldn't catch my breath. Back in April, I woke up with stabbing back pain and feeling like I couldn't breathe - and that time lasted 2 or 3 hours. In August when it happened, I had eaten swordfish at the reception. I vomited and I felt 90% better after that. I don't know if it was from the fish or what. I went to ER, when I came back in state after the wedding. Next month, I am having a stress test done. I followed up with primary and with Cardiologist, it was a new cardiologist - and he put me on a cholesterol medicine and the name was: I have been on it for 10 days: Atorvastatin - 20 mg. I have a stress test that I requested . I don't have a follow again until next year. I feel fine right now. There is no cardiac history in my family. I go to the gym. Not sure if this is related to vaccine.

Other Meds: Loratadine - 10 mg; baby aspirin 81 mg; Movefree - for joint mobility; Vit D3 - 1000 units; calcium 1200 units; elderberry gummies; Beauty - contains Biotin, Vit C, E and Carotene - for hair, skin and nails; Multivitamin gummy

Current Illness: no

ID: 1779650
Sex: M
Age: 24
State: CA

Vax Date: 08/18/2021
Onset Date: 09/01/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: PCN

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I have had ongoing chest pain since vaccination. I have done 12-leads as well as blood work with no indication of anything. However, since vaccination this has been an ongoing issue. Awaiting on getting an ECHO done on my heart.

Other Meds: None

Current Illness: None

ID: 1779651
Sex: F
Age: 24
State: WA

Vax Date: 09/24/2021
Onset Date: 10/01/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: The following week exactly 7 days later, I broke out in full body hives. Blister looking bumps from my chest all the way down to my feet. I went to urgent care and told the provider I haven't made any new changes, I hadn't been anywhere new, ate anything new, used any new soaps or fragrance or been around anyone who had. I have no documented allergies. I asked if it could be vaccine related and told him that I got my first dose less than 7 days ago, and he said he has seen " a lot" of cases of hives within 1 week of the 1st covid shot.

Other Meds: Spironolactone

Current Illness: None

ID: 1779652
Sex: F
Age: 7
State: CA

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None, just seasonal allergies

Symptom List: Nausea

Symptoms: Swollen, right, Red, hot and hard muscle. Happens every time she gets the flu shot.

Other Meds: Zyrtec allergy medicine

Current Illness: None

ID: 1779653
Sex: F
Age: 31
State: NC

Vax Date: 08/17/2021
Onset Date: 08/19/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data: Results for orders placed or performed during the hospital encounter of 10/12/21 Comprehensive Metabolic Panel Result Value Ref Range Sodium 140 135 - 145 mmol/L Potassium 3.3 (L) 3.5 - 5.0 mmol/L Chloride 108 (H) 98 - 107 mmol/L Anion Gap 9 7 - 15 mmol/L CO2 23.0 22.0 - 32.0 mmol/L BUN 21 7 - 21 mg/dL Creatinine 0.70 0.60 - 1.00 mg/dL BUN/Creatinine Ratio 30 EGFR CKD-EPI Female >90 >=60 mL/min/1.73m2 EGFR CKD-EPI Female >90 >=60 mL/min/1.73m2 Glucose 113 (H) 74 - 106 mg/dL Calcium 9.3 8.5 - 10.2 mg/dL Albumin 4.3 3.4 - 5.0 g/dL Total Protein 7.0 6.5 - 8.3 g/dL Total Bilirubin 0.9 0.1 - 1.2 mg/dL AST 28 14 - 38 U/L ALT 26 <35 U/L Alkaline Phosphatase 59 38 - 126 U/L Urinalysis Result Value Ref Range Color, UA Yellow Clarity, UA Clear Specific Gravity, UA >=1.030 1.005 - 1.030 pH, UA 7.0 5.0 - 7.0 Leukocyte Esterase, UA Negative Negative Nitrite, UA Negative Negative Protein, UA Negative Negative Glucose, UA Negative Negative Ketones, UA Negative Negative Urobilinogen, UA 0.2 mg/dL Bilirubin, UA Negative Negative Blood, UA Moderate (A) Negative RBC, UA 3 0 - 3 /HPF WBC, UA 1 0 - 3 /HPF Squam Epithel, UA 2 0 - 5 /HPF Bacteria, UA Occasional (A) None Seen /HPF Sedimentation rate, manual Result Value Ref Range Sed Rate 5 0 - 30 mm/h TSH Result Value Ref Range TSH 1.100 0.600 - 3.300 uIU/mL CBC w/ Differential Result Value Ref Range WBC 6.7 3.4 - 10.8 10*9/L RBC 4.45 3.77 - 5.28 10*12/L HGB 13.4 11.1 - 15.9 g/dL HCT 40.1 34.0 - 46.6 % MCV 90.1 79.0 - 97.0 fL MCH 30.1 27.0 - 33.0 pg MCHC 33.4 31.5 - 35.7 g/dL RDW 13.4 12.3 - 15.4 % MPV 9.4 9.0 - 12.0 fL Platelet 233 155 - 379 10*9/L Neutrophils % 65.6 % Lymphocytes % 28.1 % Monocytes % 4.9 % Eosinophils % 1.3 % Basophils % 0.1 % Absolute Neutrophils 4.4 1.4 - 7.0 10*9/L Absolute Lymphocytes 1.9 0.7 - 3.1 10*9/L Absolute Monocytes 0.3 0.1 - 0.9 10*9/L Absolute Eosinophils 0.1 0.0 - 0.4 10*9/L Absolute Basophils 0.0 0.0 - 0.2 10*9/L

Allergies:

Symptom List: Injection site pain

Symptoms: Onset of symptoms of raynauds phenomenon - with cold fingers and discoloration

Other Meds:

Current Illness:

ID: 1779654
Sex: F
Age: 41
State: MT

Vax Date: 06/24/2021
Onset Date: 07/23/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: 10/4/21: Halter monitor for 48hrs- showed short runs of SVT, occasional PVC with no VTach. Increased HR at times

Allergies: codine

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: heart palpitations - started near the end of July and worsened across August and September (still on-going).

Other Meds: pre-natal vitamin, baby aspirin

Current Illness: Pregnancy miscarriage

ID: 1779655
Sex: F
Age: 44
State: MA

Vax Date: 08/27/2021
Onset Date: 08/29/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Echocardiogram normal, labs, normal, tested for autoimmune disorders, normal

Allergies: None

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: Within 48 hours I could not feel my legs, they felt disconnected from my body. I had trouble walking. Horrible brain fog, I felt like I was in a dream. I went to the ER 4 times and I have been working with my PCP and immunologist. Currently I am still suffering from bad tremors, pins and needles stabbing me in my entire body and face. I have tinnitus, really bad ringing in my ears. Weakness, muscle spasms in my legs. 3 toes are numb. A lot of pain in my extremities. Sensitivity to temperature, anything hot makes me feel sick and activates my tremors. I use a walker to walk because I do not have balance. I suffer from vertigo and I feel like I am going to fall. I have tachycardia. I had really high blood pressure but it has now come down. My heart is getting better. I had an echocardiogram and it was normal. I still have some tachycardia but it is intermittent. I have trouble with my speech and remembering words. I have trouble holding on stuff. I am always nauseous. Now I have full body convulsions that las about 10 minutes. Following these episodes I get very ill and have a severe headache and a blurry vision. I have been tested for autoimmune disorders and have had labs done, everything has come back normal. I am scheduled for an MRI but it is until the end of October. 3 doctors have concluded that this was caused by the vaccine.

Other Meds: Biweekly infusion for hypogammaglobulinemia CUVITRU (IGG Therapy)

Current Illness: None

ID: 1779656
Sex: F
Age: 74
State: CA

Vax Date: 03/27/2021
Onset Date: 04/10/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: all came back normal.

Allergies: Amoxicillin, shrimp

Symptom List: Tremor

Symptoms: Two weeks to the day of my second shot I woke up with extreme chills, vomiting, diarrhea, and a 103 fever at 7:30 in the morning. My family member took me to the ER where I was treated. I was released that day, but continued being feverish for a few days more and broke out with an extreme case of shingles/herpes under my right eye. Since then I have twice been admitted to the ER with tachycardia.

Other Meds: Eliquis, losartan

Current Illness: n/a

ID: 1779657
Sex: F
Age: 69
State: WA

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: dill

Symptom List: Erythema, Pruritus

Symptoms: The injection was VERY painful and (according to the nurse at the second injection) was given in the wrong part of the arm - the front-facing part of the arm rather than the side. It was also suggested that she hit a nerve because later that day and for several weeks after I would have pain in the upper muscle, moving horizontally around the muscle, not vertically up and down the arm. I've continued to have pain and movement of the arm has been impaired.

Other Meds: levetiracetam, lamotrigine

Current Illness: none

ID: 1779658
Sex: F
Age: 58
State: WA

Vax Date: 04/12/2021
Onset Date: 10/01/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data: None

Allergies: Bacterium; IV Contrast Dye; Flu vaccine

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: Rashes occurred after the 1st dose and continued after 6 months after the second shot. Rash stomach on back. It would rotate from different spots of my back and stomach. Rashes stopped in September.

Other Meds: Nexium; Oxycodone; Zyrtec- allergy medication; Allegra - allergy medication; Coalase; Vitamin D; Vitamin B12

Current Illness: None

ID: 1779659
Sex: F
Age: 68
State: CT

Vax Date: 02/10/2021
Onset Date: 03/03/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Total cardiology workup at office of Dr., including a nuclear stress test in March 2021. Results were negative. Between June and August 2021, I wore a holter monitor, and the results were inconclusive.

Allergies: Sensitivity to chocolate.

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: I received my first dose of Moderna on 1/8/2021 and my second on 2/10/2021. On 3/3/2021 at about 11:00 PM, I had an episode of atrial fibrillation that lasted 3 hours. I went to the emergency room at local hospital. They were going to give me medicine to treat the fibrillation, but it broke spontaneously, so I didn't need the medicine. I then went home afterwards. A few weeks later, I had a total cardiology workup that included a nuclear stress test, which was negative. I had an atrial fibrillation for the first time in February 2020. Since receiving the vaccines, I have had three fibrillations. As well as the abovementioned episode, I also had episodes in June 2021 and on 10/3/2021. Each time, I went to the ER at local hospital, and each time the fibrillations spontaneously broke, thus making it unnecessary for me to get the medication. After the episode in June, they gave me Eliquis, which is a blood thinner. Between June and August, I wore a halter monitor, and the results were inconclusive.

Other Meds: Paxil; omeprazole; Singulair; rosuvastatin; metoprolol; baby aspirin; Ozempic; vitamin D.

Current Illness: None.

ID: 1779660
Sex: F
Age: 61
State: PA

Vax Date: 04/09/2021
Onset Date: 06/20/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Right foot x-ray 8/20/21: Normal Sed rate 8/20/21: 43 C-Reactive Protein 8/20/21: 1.7 CBC 8/20/21: Normal Pulse volume, seg. arterial limb pressure, doppler spectral analysis of R & L lower extremeties: Normal

Allergies: Penicillin, Keflex, Aspirin, Macrolides, cloth/adhesive tape, silk. Intolerance to erythromicin and statin drugs.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I woke up on 6/20/21 with a fever and shaking chills (no thermometer in the house). By 6 PM developed redness, swelling, and skin dimpling on the front of my right lower leg. I had had a small wound on the 3rd right toe, caused by a hammertoe, and that toe was also hot, swollen and painful. I am a retired RN and recognized the onset of cellulitis. I used tylenol to control the fever. I visited an Urgent Care clinic on Monday the 21st of June and was seen by a nurse practitioner. She prescribed a 10-day course of doxycycline and suggested that I see a podiatrist because the toe wound seemed to be the source. After the 10 days, the leg cellulitis was resolved but the toe remained swollen. I then saw a podiatrist, who prescribed a 10 day course of Levaquin. I have had frequent visits with the podiatrist to treat the toe wound, which is finally resolved.

Other Meds: Multivitamin, Calcium supplement, Xstampza, Levothyroxine, Lisinopril, Maxide, Januvia, Amitriptaline, Duloxatine, probiotic, red yeast rice, Pepcid

Current Illness: None

ID: 1779661
Sex: M
Age: 43
State: MT

Vax Date: 10/07/2021
Onset Date: 10/09/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: no doctor consulted

Allergies:

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: patient got shot Thursday am 10/7, but Saturday morning 10/9 was experiencing underarm tenderness/pains in underarm on left side and swollen lymph nodes, temporarily lost feeling in left arm...also had some shortness of breath on sunday that has since resolved, and some diarrhea on Monday

Other Meds:

Current Illness:

ID: 1779662
Sex: F
Age: 38
State: CA

Vax Date: 09/08/2021
Onset Date: 09/09/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: Pt healthy 38 year old female s/p moderna covid-19 immunization 9/8/21 developed numbness/tingling bilateral hands and arms and encephalopathic brain changes- unable to calculate or do her daily accounting job.

Other Meds:

Current Illness:

ID: 1779663
Sex: F
Age: 64
State: OH

Vax Date: 04/08/2021
Onset Date: 04/25/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: Seborrheic dermatitis occurred after the second dose about two weeks after injection that is mostly concentrated on the legs that look like mosquito bites. Hydrocortisone cream does not work, coconut oil did not work either. Seborrheic dermatitis on my face is slowly improving as well.

Other Meds: Metamizole; metoprolol; olmesartan

Current Illness: N/A

ID: 1779664
Sex: F
Age: 43
State: MD

Vax Date: 02/09/2021
Onset Date: 03/06/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data: CT scan, EKG, lab work

Allergies: All forms of amoxicillin

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: I noticed my eye, could not see properly, the light was bothering me so bad. I could not open them up. It felt like I had cotton in them. The day after my vaccine, I woke up and went outside to go to work, I could not see, my eye were very sensitive. At work a nurse looked at my eyes and my eyes were fully dilated at 9mm. I called my PCP and she told me to go to the ER. By the time I got to ER, my BP 205/190, thought I was having a stroke. I got a CT scan, EKG, some blood work and they said I was okay but they could not figure why my eyes were like that. They told me after few hours, to follow up with a neurologist and an ophthalmologist. I also saw a Dr., neurologist. I went to ER at local medical center. I also went to an eye doctor. My right eye keeps dilating still right now and ever since my eyes starting this dilation thing, I can not see up close. I have to wear glasses now. When my right eye gets dilated, I feel a pressure sensation and also get a lot of headaches. I always had migraine on and off through my life but since the vaccine I have never had eye problems. Ever since the vaccine, I have constant headaches. I do not have lot# to provide.

Other Meds: I was on medication and daily vitamins.

Current Illness: High blood pressure

ID: 1779665
Sex: F
Age: 26
State: IN

Vax Date: 06/17/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Nine

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Became pregnant July 15, 2021 and was diagnosed with fetal acrania on October 12, 2021. No previous history of fetal abnormalities.

Other Meds: None

Current Illness: None

ID: 1779666
Sex: F
Age: 71
State:

Vax Date: 07/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/12/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1779668
Sex: F
Age: 61
State: CA

Vax Date: 04/27/2021
Onset Date: 05/02/2021
Rec V Date: 10/12/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: unknown

Allergies: Xanax, Zyperca, Cipro,

Symptom List: Vomiting

Symptoms: after the vaccine, i got alot of symptions, loose stool, aniexty, depression, and gastric, start after the vaccine,

Other Meds: Vitman D. Effexor 75mg Depeoke 125 mg Bystolic

Current Illness: urine infection

ID: 1779669
Sex: M
Age: 72
State: NY

Vax Date: 09/30/2021
Onset Date: 10/05/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Unknown

Allergies: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient developed Bell's Palsy 1 week after 3rd dose of vaccine.

Other Meds: None

Current Illness: None

ID: 1779670
Sex: F
Age: 23
State: KY

Vax Date: 02/11/2021
Onset Date: 10/03/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Labs: Recent Results (from the past 24 hour(s)) CBC w/Diff Collection Time: 10/03/21 1:15 AM Result Value Ref Range White Blood Count 4.54 4.5 - 11.0 10*3/uL Red Blood Count 4.21 4.0 - 5.2 10*6/uL Hemoglobin 12.6 12.0 - 16.0 g/dL Hematocrit 39.2 36.0 - 46.0 % Mean Corpuscular Volume 93.1 80.0 - 100.0 fL Mean Corpuscular Hemoglobin 29.9 26.0 - 34.0 pg Mean Corpuscular HGB Conc 32.1 31.0 - 37.0 g/dL Red Cell Distribution Width-CV 12.5 12.0 - 16.8 % Platelet Count 241 140 - 440 10*3/uL Mean Platelet Volume 10.1 8.4 - 12.4 fL Diff Type Hospital CBC w/AutoDiff (arb'U) Neutrophils % 59.1 45 - 80 % Lymphocyte % 26.0 15 - 50 % Monocyte % 13.0 0 - 15 % Eosinophil% 1.5 0 - 7 % BASO% 0.2 0 - 2 % Immature Granulocyte% 0.2 0.0 - 1.0 % Nucleated RBC % 0 0 /100(WBC) Neutrophil Abs 2.68 2.0 - 8.8 10*3/uL Lymphocyte-Absolute 1.18 0.7 - 5.5 10*3/uL Monocyte Absolute 0.59 0.0 - 1.7 10*3/uL EOS-Absolute 0.07 0.0 - 0.8 10*3/uL Basophil Abs 0.01 0.0 - 0.2 10*3/uL Immature Granulocyte Abs 0.01 0.00 - 0.10 10*3/uL HCG,Qualitative Collection Time: 10/03/21 1:15 AM Result Value Ref Range HCG Qualitative Serum Negative Negative Radiology: Xr Chest 2vw Result Date: 10/2/2021 REVIEWING YOUR TEST RESULTS IN MYNORTONCHART IS NOT A SUBSTITUTE FOR DISCUSSING THOSE RESULTS WITH YOUR HEALTH CARE PROVIDER. PLEASE CONTACT YOUR PROVIDER VIA MYNORTONCHART TO DISCUSS ANY QUESTIONS OR CONCERNS YOU MAY HAVE REGARDING THESE TEST RESULTS. RADIOLOGY REPORT FACILITY: ER AGE:24 Y SEX:F XR CHEST 2VW DATE: 10/02/2021 HISTORY: cough. COMPARISON: August 28, 2021. FINDINGS: Two views of the chest demonstrate no pneumonic consolidation, pleural effusion, or pneumothorax. The cardiac and mediastinal contours are normal. IMPRESSION: 1. No acute cardiopulmonary radiographic abnormality. .

Allergies: No known allergies

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: presents to the ED with frontal headache, cough productive of small clear sputum, sore throat, myalgias, fatigue and chills. She denies fever, dyspnea, sinus drainage, postnasal drip, nausea/vomiting, diarrhea, dysuria, hematuria, urinary urgency or frequency. Recommended Benzonatate 100mg (2capsules by mouth, 3x daily), Prednisone 4mg tablet dospack cetirizine 10 MG tablet Commonly known as: ZyrTEC Take 1 tablet by mouth daily for 30 days May substitute for cost/insurance purposes. Flovent HFA 110 MCG/ACT inhaler Generic drug: fluticasone Inhale 2 puffs into the lungs Twice a Day. ibuprofen 600 MG tablet Commonly known as: MOTRIN Take 1 tablet by mouth every 8 (eight) hours as needed for Pain or Fever for up to 24 doses. Mucus Relief DM 30-600 MG Tab sr12 Take 2 tablets by mouth every 12 (twelve) hours. naproxen 500 MG tablet Commonly known as: Naprosyn Take 1 tablet by mouth 2 (two) times daily with meals. Review of Systems Constitutional: Positive for activity change, appetite change, chills and fatigue. Negative for diaphoresis and fever. HENT: Positive for sore throat. Negative for nosebleeds, congestion, rhinorrhea, trouble swallowing, neck pain, neck stiffness, voice change, postnasal drip and tinnitus. Eyes: Negative for visual disturbance. Respiratory: Positive for cough. Negative for chest tightness and shortness of breath. Cardiovascular: Negative for chest pain, palpitations and leg swelling. Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting. Genitourinary: Negative for dysuria, flank pain and hematuria. Musculoskeletal: Positive for myalgias. Negative for gait problem. Skin: Negative for wound. Neurological: Positive for headaches. Negative for dizziness, syncope, light-headedness and numbness. Psychiatric/Behavioral: Positive for sleep disturbance. Negative for confusion. The patient is nervous/anxious.

Other Meds: None

Current Illness: No known illnesses

ID: 1779671
Sex: F
Age: 29
State: FL

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/a

Allergies: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Aug 28 the day of vaccine was 4:00 pm at 7:00 of that day my lip and chin was itching my lip was swollen I took benedryl subsided within 24 hrs sept 11 my upper lip became swollen again very firm to touch I took benedryl the swelling went down sept 14 my lip because itchy swelling my jaw was swelling firm to touch my right had hives sept 15 I went to urgent care to get steroid shot and a prescription of prednisone

Other Meds: No

Current Illness: No

ID: 1779672
Sex: F
Age: 45
State: NC

Vax Date: 10/10/2021
Onset Date: 10/12/2021
Rec V Date: 10/12/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Requested MRI of the brain with and without constast and LP

Allergies: Azithromycin

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: At noon on 10/12/2021 patient developed double vision

Other Meds: None

Current Illness: None

ID: 1779673
Sex: F
Age: 48
State: MA

Vax Date: 04/12/2021
Onset Date: 09/01/2021
Rec V Date: 10/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: mild to moderate allergies to trees, weeds, grasses, mold, dust mite, and some foods

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: About 4.5 months past my 2nd Pfizer dose, I developed new or increased intolerance to all legumes. 15-30 minutes after eating legumes (especially chickpea, soy, and pea), I get diarrhea. I have had to eliminate legumes from my diet.

Other Meds: Zoloft 25mg, Tumeric, Calcium with D

Current Illness: new allergic reaction to pecans (itchy ears, bronchial spasm)

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am